Cardiac arrest in pacemaker patient

[confusedmedstudent22]

Hi, I apologize if this is a dumb question in advance.

Was at a code blue today. Normally students don't get to help out but since it was the holidays, I was glad to get involved since fewer people around.

Patient unresponsive and was known to have a implanted pacemaker. After 2 compressions, the family told us to stop because they didn't want any intervention other than an oxygen mask only. When I looked at the rhythm, they appeared to have a what I would have called PEA (narrow complex, but don't remember other than that). However, when I felt their femoral artery (and another nurse noted), they appeared to have faint, thready pulses. Does this count as a pulse? The attending pronounced the patient shortly after. Also, how does an arrest occur with a pacemaker in place? Thanks!

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[Daiphon]

If you have a pulse, it counts... but if family (most importantly next of kin/POA) says stop, you stop.

As for codes with pacers - you hit it on the head: PEA arrest.

-d

 

[Smurfette]

This reminds me of the first time I was called to pronounce a patient as an intern. The patient was DNR, on a vent and had a pacemaker, so breathing and a (paced) rhythm were both present and the art line registered a very low BP with every heart beat. My senior thought I was an idiot when I called him to ask if it was ok to pronounce the patient. LOL.

 

[confusedmedstudent22]

If you have a pulse, it counts... but if family (most importantly next of kin/POA) says stop, you stop.

As for codes with pacers - you hit it on the head: PEA arrest.

-d

Just to clarify so I know for the future... if the patient still had a pulse, how can it be called PEA? And how can they be pronounced dead? Or is it the fact that without CPR, they will be dead imminently?

 

[TraumaLlamaMD]

A pacemaker can produce electrical activity, but if the patient's heart isn't strong enough to actually pump out enough blood, you won't feel a pulse and their brain won't be perfused.

 

[confusedmedstudent22]

A pacemaker can produce electrical activity, but if the patient's heart isn't strong enough to actually pump out enough blood, you won't feel a pulse and their brain won't be perfused.

But if they still have a pulse (albeit thready, weak) how can you already pronounce them before that stops?

 

[Rendar5]

They either called them early or you were only feeling the pulse from your fingertips, both of which can happen. You won't get a pulse from a ppm but you will get electrical activity. Turn the monitor off. Btw physicians will sometimes call too early. The heart can do crazy things sometimes. I once had a pt achieve rosc even with cardiac standstill on u/s 1 minute after calling it. He was a typical gomer, woke up 2 days later and left Ana after cursing out the staff.